EBP Project Abstract
Appraised by:
Karalyn Klipfel (SN), Jessica Lybeck (SN), Kim Pritchett (SN)
NDSU Nursing at Sanford Health, Bismarck, ND
Clinical Question:
In critically ill/ immune compromised patients does using sterile water versus tap water in medication
administration via enteral feeding tube decrease the risk of infection?
Articles:
Boullata, J., Brantley, S., Corkins, M., Guenter, P., Krenitsky, J., Lyman, B., …Wessel, J.
(2009). Enteral nutrition practice recommendations. Journal of Parenteral and Enteral
Nutrition, 33, 122-167. http://dx.doi.org/10.1177/0148607108330314
Padula, C. A., Kenny, A., Planchon, C., & Lamoureux, C. (2004). Enteral feedings: what the
evidence says. American Journal of Nursing, 104, 62-69. Retrieved from
http://ovidsp.tx.ovid.com.ezproxy.lib.ndsu.nodak.edu/sp3.14.0b/ovidweb.cgi?&S=ECODFPGMFADDMPOHNCKKCHMCDGAPAA00&Link+
Set=jb.search.29%7c1%7csl_10
Schloerb, P. R., Wood, J. G., Casillan, A. J., Tawfik, O., & Udobi, K. (2003, October 9). Bowel
necrosis caused by water in jejunal feeding. Journal of Parenteral and Enteral Nutrition,
28, 27-29. Retrieved from
http://pen.sagepub.com.ezproxy.lib.ndsu.nodak.edu/content/28/1/27.full.pdf+html
Synthesis of Evidence:
As stated by (Schloerb, Wood, Casillan, Tawfik, & Udobi, 2003), a number of patients, as well as animal
studies, are supporting a 1940 findings by Dennis that point toward distilled and normal saline, in the
cases described the patients presented with different issues but the common factor between them was the
use of water jejunal feedings. The previous and current findings are “cause is unclear and that the
pathophysiology seems complex.” Therefore the article recommended that distilled or tap water can
injure the small bowel thus resulting in complications. It is recommended that normal saline be used over
distilled or tap water.
Padula, Kenny, Planchon, & Lamoureux,( 2004) created a new set of guidelines for enteral feeding
procedures and policies to decrease the rate of infection and complications in the critically ill and
immunocompromised patients receiving enteral nutrient. They determined there was a variety of things
that can be done to decrease infection and complications such as washing hands. Wearing non-sterile
gloves and tap water may be used if the safety is determined, otherwise sterile water should be used in the
immunocompromised and the critically ill, among many other guidelines. The research and the
guidelines this institution adapted were based on the research.
The Enteral Nutrition Practice Recommendations Task Force (Boullata et al., 2009) examined the
literature that was available relating to enteral feedings ordering, preparation, delivery and monitoring of
them and also to establish evidence-based practice guidelines that deal with types of water to be used in
enteral feedings, hang times, and the stability of the feedings..
Although there is controversy between using sterile water over tap water, it has been recommended that
sterile water should be used with medication administration in the critically ill/ immunocompromised.
This change would decrease the chance of infection which would, decreased patient length of stay, and
thus decreasing medical costs.
In the research we found different types of studies researching this topic. We found several guidelines
which recommend the use of sterile water. These studies have been done in different areas of the hospital
and labs which included both animals and humans, both yielding the same results.
Bottom Line (findings):
Using sterile water for enteral medication administration has been shown to decrease the chances of
infection compared to tap or distilled water. By using sterile water, patient’s clinical outcomes may be
improved and length of stay may decrease. There have not been any adverse effects reported with using
sterile water.
Implications for Nursing Practice:
Practice recommendations would include developing a policy to use sterile water when administering
enteral medication. Sterile water is shown to be more safe and effective than tap or distilled water.